Self Injury - not so secretive anymore.

Most self-injurers hurt themselves in private and then hide their scars because of shame and guilt.

They wear long sleeves in the summer. Avoid shorts when it's hot. And say no to opportunities where their secrets may be exposed. They belong to a growing number of people who engage in the act of self-injury.

Self-Injury or SI is the behaviour of harming oneself without suicidal intent. Joan Kimball, a licensed psychologist and Trinity Western University associate professor in Counselling Psychology, has been studying the disorder for years. She believes that it is a psychological and physiological way of coping. "This act of self-harming seems to help regulate emotional activity in those who have difficulty coping with overwhelming emotions" says Kimball.

According to Kimball, the most common methods of self-injury include scratching, hitting and burning. Less often self-injurers participate in things like swallowing glass, rubbing broken glass on the skin, and imbedding objects under the skin. In extreme cases self-injurers will cut their stomachs and reopen wounds.

Says Kimball, "There is some interesting research which points to the idea that endorphins in the brain are being released when a person self-injures. For some it calms them down and in others it can lead to further arousal. As researchers we don't really know the biological mechanisms but we believe it's a multi-functional behaviour that can serve a wide variety of purposes. Self-injury can also be symbolic, such as an outward expression of how much inner pain the person is experiencing, or it can trigger a disassociated state. And for those who have had a history of trauma, self-injury can bring them out of this disassociation. So it's not the same for everyone."

Kimball has observed that self-injury can lessen in some people as they get older. "In my own view there seems to be two types of self-injurers. For some it starts in adolescence and resolves in the early 20's. For this person, SI was essentially a coping mechanism that they used throughout a particularly rough patch in their lives. Now, as they have matured they have learned other ways of dealing with emotions that don't involve self-harm. The second type of person is an individual with more chronic behaviour. The action of SI, and the issues underlying the behaviour, were more severe in childhood or adolescence, resulting in this action of self-injury being entrenched in their lives."

It's hard for those that don't self-injure to understand how this action that causes physical pain can possibly make a person feel better. Most self-injurers hide their scars because of shame and guilt, and when others see the scars or marks of harm it can make them feel uncomfortable, creating a social stigma towards the self-injurer.

Kimball explains, "I think it's a normal reaction to the idea that someone would want to hurt themselves. It is ‘normal' to take care of yourself, and it's very difficult to understand the intentionality of hurting oneself. The idea brings up confusion and judgment, and people don't understand it. There are even attitudes in some hospitals that ‘we take care of those that are really hurt, not those that hurt themselves.' This attitude or stigma perpetuates the notion of guilt and shame."

The psychologist first became aware of self-injury after working at Western Washington University. There Kimball noticed that on College and University campuses there seemed to be more and more cases of students deliberately harming themselves. Since then Kimball has been continuing to study and has received funding for an in international study that is asking therapists what techniques and theories are proving to be successful in the treatment of SI. According to Kimball there has been very little research about "what works" in the treatment of deliberate self-harm and it is hoped that her research will provide therapists more concrete information on the prevention and treatment of SI.

From clinical study and research, Kimball has seen success in therapy sessions by using a holistic approach. She concentrates on helping sufferers find alternative ways to manage their emotions. "Sessions should explore with the person what specific function SI plays in their lives and how it developed. One of my firm beliefs as a therapist is that there is a reason why people do what they do. Often self-injury is done alone. Part of treatment involves creating a safe relationship within which self-injurers can feel accepted while they explore their feelings and make changes in their lives."

Joan Kimball resides in Bellingham, Washington. When she is not researching, she works part-time in private practice. She is also affiliated with Associates in Mental Health.